Levels Of Organization Research Articles

Short and Effective: A Reasoned Proposal for Organizational Climate Measurement

Generally, organizational climate research does not focus on the work environment because the mindset and emotions of employees are often mistaken for organizational culture. Additionally, surveys to evaluate the organizational climate tend to be long, and therefore, organizational climate studies are conducted only once a year—that too if an organization is concerned about its employees. This research proposes a methodology to evaluate organizational climate; the methodology has the following characteristics: it is a short evaluation named “pulse”; it is oriented toward specific elements of culture that influence the organizational climate and its variability; and it considers organizational contexts. The study was conducted in three organizations encompassing three sectors (N=3,331 employees). The survey included three questions regarding employees’ feelings and climate perception at the individual, group, and organizational levels. Additionally, it had 56 questions related to the elements of organizational culture, grouped into six components after an exploratory analysis: Structure, Recognition, Leadership, Accountability, Work Team, and Ethics. The results showed significant differences between organizations based on the organizational climate perception, its strength, and the behavior of the variables associated with the organizational culture that impacts the climate. Additionally, cultural elements were reduced because of their relationship with the organizational climate. This research suggests that organizational climate studies should be conducted for specific organizational contexts. Additionally, it proposes a methodology to reduce the duration of organizational climate studies by focusing on specific cultural dimensions associated with the climate, which can be applied longitudinally throughout the year to monitor climate changes. Doi: 10.28991/ESJ-2024-08-05-09 Full Text: PDF

Investigating the impact of a multicomponent positive participatory organisational intervention on burnout in New Zealand emergency department staff: a prospective, multisite, before and after, mixed methods study.

The well-being of healthcare workers (HCWs) is critical to providing excellent care. Recent evidence concerns the well-being of emergency department (ED) HCWs in New Zealand, with high levels of burnout found in a 2020 survey. This threat to providing high-quality acute care warrants improvement interventions. The causes of burnout are complex and multifactorial, the solutions are not straightforward. A prospective, multisite, before and after, mixed methods study assessing a multicomponent intervention, adaptable to local context, that targets three organisation levels (the individual, the group and the system levels) and meaningfully involves frontline HCWs may reduce HCW burnout and improve HCW well-being. Individual HCWs will choose from three individual-level psychological interventions and participate in those most appropriate for them. Local champions will decide which group-level intervention their ED will use. The system-level intervention will build capacity and capability for quality improvement (QI) with QI training and the establishment of a Quality Improvement Learning System. This system-level intervention has several important features that may ultimately empower HCWs to contribute to improving the quality of ED healthcare.We will enrol nine EDs, from which there will be at least 900 HCW participants. EDs will be enrolled in three waves from March 2023 to April 2024, with interventions taking place in each ED over 12 months.Methods of assessment will include baseline and repeat survey measures of burnout and well-being. Process evaluation at each ED will provide details of context, the intervention and the fidelity of the implementation. Ethics committee approval was provided, with locality approval at each site.Individual site feedback will be provided to each ED and executive leadership. Dissemination of findings will be through publication in peer-reviewed journals, presentation at national and international scientific meetings and through national healthcare quality bodies. Australia New Zealand Clinical Trials Registry (ACTRN12623000342617).

Karen J. Foli: A Nurse Scholar With an Unconventional Trajectory.

Nurse scholar Karen J. Foli has had an unconventional trajectory. She has written everything from mysteries to thrillers to peer-reviewed journal manuscripts and Food and Drug Administration documents. She conceptualized and disseminated two middle-range theories, one surrounding parental postadoption depression and one surrounding nurses' psychological trauma. Foli's research has revealed a new type of nurse-specific trauma, insufficient resource trauma, which calls for efforts at the organizational level. Winner of several book of the year awards, she is now working on a third middle-range theory. Dr. Foli shares her journey and encourages nurses to give theory a shot.

Understanding healthcare professionals’ responses to patient complaints in secondary and tertiary care in the UK: A systematic review and behavioural analysis using the Theoretical Domains Framework

BackgroundThe path of a complaint and patient satisfaction with complaint resolution is often dependent on the responses of healthcare professionals (HCPs). It is therefore important to understand the influences shaping HCP behaviour. This systematic review aimed to (1) identify the key actors, behaviours and factors influencing HCPs’ responses to complaints, and (2) apply behavioural science frameworks to classify these influences and provide recommendations for more effective complaints handling behaviours.MethodsA systematic literature review of UK published and unpublished (so-called grey literature) studies was conducted (PROSPERO registration: CRD42022301980). Five electronic databases [Scopus, MEDLINE/Ovid, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Health Management Information Consortium (HMIC)] were searched up to September 2021. Eligibility criteria included studies reporting primary data, conducted in secondary and tertiary care, written in English and published between 2001 and 2021 (studies from primary care, mental health, forensic, paediatric or dental care services were excluded). Extracted data included study characteristics, participant quotations from qualitative studies, results from questionnaire and survey studies, case studies reported in commentaries and descriptions, and summaries of results from reports. Data were synthesized narratively using inductive thematic analysis, followed by deductive mapping to the Theoretical Domains Framework (TDF).ResultsIn all, 22 articles and three reports met the inclusion criteria. A total of 8 actors, 22 behaviours and 24 influences on behaviour were found. Key factors influencing effective handling of complaints included HCPs’ knowledge of procedures, communication skills and training, available time and resources, inherent contradictions within the role, role authority, HCPs’ beliefs about their ability to handle complaints, beliefs about the value of complaints, managerial and peer support and organizational culture and emotions. Themes mapped onto nine TDF domains: knowledge, skills, environmental context and resources, social/professional role and identity, social influences, beliefs about capability, intentions and beliefs about consequences and emotions. Recommendations were generated using the Behaviour Change Wheel approach.ConclusionsThrough the application of behavioural science, we identified a wide range of individual, social/organizational and environmental influences on complaints handling. Our behavioural analysis informed recommendations for future intervention strategies, with particular emphasis on reframing and building on the positive aspects of complaints as an underutilized source of feedback at an individual and organizational level.

You're More Resilient Than You Give Yourself Credit For: Building Resilience in Times of Change and Challenge

This article examines the concept of resilience and strategies for building resilience at the individual and organizational levels. It defines resilience as the ability to withstand challenges and adapt to change. The article explores how cultivating certain cognitive habits and support systems can enhance individual resilience. These include maintaining an adaptive mindset, developing strong social networks, finding purpose in one's work, and prioritizing self-care, especially during stressful periods. It also analyzes how structural elements and cultural dynamics within an organization can build its resilience. Attributes like flexible structures that enable adaptation, learning-oriented cultures, a clear sense of shared purpose, and resilient leadership styles are linked to an institution's capacity to manage challenges. The article provides practical recommendations for developing resilience through practices such as strengthening social connections, rewarding risk-taking and growth, openly acknowledging uncertainties, and role modeling resilient behaviors. It argues that proactively building resilience reserves empowers individuals and organizations to survive difficulties and emerge stronger.

Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study.

Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies. Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach. Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies. Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.

How has health literacy and digital health literacy scholarship evolved? A global, qualitative study.

Health literacy (HL) is a key social determinant of health (SDoH) and is of increasing importance in public health research and intervention for improved health outcomes. Definitions of HL and digital health literacy (DHL) have evolved over time as the field has expanded conceptualization from an individual focus to the broader community and organizational levels. Careful consideration of HL and DHL for a variety of contexts and audiences is critical given increased global adoption of digital technologies and responses to emerging public health challenges. This study aimed to capture researchers' conceptualizations of HL/DHL and their motivations to engage in this research with attention to SDoH and equity principles. We developed a survey comprising 32 open-ended and multiple-choice questions from which we present participant demographics and overall research affiliations (n = 193), and results from two multiple-choice and three open-ended questions. The three open-ended questions were inductively reviewed and coded using thematic analysis and iterative discussions between multiple coders, while the two multiple-choice questions were descriptively analyzed via SPSS. Findings are situated within the context of the coronavirus disease 2019 (COVID-19) pandemic and inform the international field of HL/DHL research by highlighting momentum and opportunities for increased scholarship.

Moral distress and protective work environment for healthcare workers during public health emergencies

BackgroundPublic health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors.ObjectivesThe current study aimed to examine: [1] risk factors associated with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic.MethodsWe employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic.ResultsAbout half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30–2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0–10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress.ConclusionsOur findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs’ work environment.

Patterns of girdle shape and their correlates in Australian limb-reduced skinks.

The evolution of limb reduction in squamates is a classic example of convergence, but the skeletal morphological patterns associated with it are underexplored. To provide insights on the biomechanical and developmental consequences of transitions to limb reduction, we use geometric morphometrics to examine the morphology of pectoral and pelvic girdles in 90 species of limb-reduced skinks and their fully limbed relatives. Clavicle shapes converge towards an acute anterior bend when forelimbs are lost but hindlimbs are retained-a morphology typical of sand-swimmers. This may either indicate functional adaptations to locomotion in fine substrates, or a developmental consequence of complete limb loss. The shape of limb-bearing elements of both girdles (coracoid and pelvis) instead closely mirrors limb reduction, becoming more simplified as undulation replaces limbed locomotion. Integration between girdles decreases in taxa lacking elements of the forelimbs but not hindlimbs, indicating differential selection on each girdle in response to distinct locomotory strategies. However, this pattern becomes less clear when considering phylogenetic history, perhaps because it is limited to one specific clade (Lerista). We show how the functional demands of locomotion can induce changes at different levels of organismal organization, including both external and internal structures.

Creating Positive Customers Evaluation: The Impact of Efficient CRM Processes on Increasing Client Satisfaction

Commodity creation took precedence over endurance as the industrial revolution of the first half of the twentieth century led to the digitization of industrial techniques. Subsequently, the focus shifted to promotional elements that gave priority to consumer satisfaction. The technological advancements of the 20th century and globalization have brought humans to the highest levels of the asset organization, which has had a profound impact on employment. Ancient Hindu texts such as demonstrate the importance of human resources and demonstrate that structured management of human personnel dates back thousands of years. However, the first signs of the evolution of Hrd (human capital administration) approaches date back to the 1780 factory insurrection. During this time, technological breakthroughs necessitated improved work practices, productivity, and quality. The financial advantages of splitting of labor were discussed by Smith (1776) in his work “An Enquiry into the Causes and Nature of Wealth of Nations.” He suggested that specialization could increase the efficiency of labor. He perceived three benefits from a separation of labor: skill growth, time savings, and the ability to use specialized instruments. The creative endeavor of Owen (1825) demonstrates the significance of individuals in the operation of businesses. He maintained that one of the most effective expenditures managements can make is money invested in personnel development. Babbage (1832) investigated and developed the concept of specialization of labor in an even more thorough matching of individual expertise and abilities with particular tasks, based on his work, he came to that conclusion. As the work of Taylor (1911) tried to codify worker situations, procedures, methods, and tacit talents into concrete norms and formulae, a revolutionary shift occurred in the realm of interpersonal management practices. Research on the connection among productivity and the workplace was first undertaken by Mayo and his colleagues in 1927–1932. Barnard (1938) and other researchers followed up on these groundbreaking studies, which completely changed the realm of hiring and firing methods. The controversy about if effective human resources management is just jargon or a real concept is still up for debate, despite the fact that there has been a sizable body of literature on the subject. By analyzing the level of strategic HRM implementation and its effects on organizational performance in Nigeria’s manufacturing sector, this report aimed to expand the scope of previous research. The stated goal of the multi-respondent survey, which included 21 manufacturing organizations in the nation of Nigeria, had been to find a fit among corporate success and strategic staffing practices. The data obtained was evaluated using descriptive statistics, regression analysis, and correlational analysis. Results indicate that production enterprises in Nigeria employed moderate amounts of tactical HRM. Findings also show this path The main tactical human resources procedures that affect the effectiveness of organizations in Nigeria’s manufacturing sector are management devolution, creative hiring and hiring methods, ongoing workers education and training, based on shares compensation, performance appraisal, professional development, and active employee involvement in decisions and actions. It follows that businesses involved in production should focus more on these procedures in order to enhance their use throughout the sector.

Legal personhood and care for elderly parents in Indonesia

In one of her last articles, K. von Benda-Beckmann explores the notion of embeddedness of persons in their social world and how this relates to their duty of care (2021). She found that there may be different degrees of embeddedness; that some people are not only bounded to their social relations and environment, but also that their selves extended to include their social world. She suggested a differentiated analysis that could account for these differences and expects this to benefit in understanding care relations and, on a practical front, to offer unexpected strategies in dealing with injuries. This paper continues this framework by looking into legal pluralism and the relinquishing of legal personhood of elderly parents across different levels of social organizations, from the decision-making within families and into the courtrooms. What are the reasons for- and how are individuals being declared as no longer having agency or legal personhood (legal competency)? How does this relate to extending proper care to family members and (or in opposition to) others? And in more abstract terms, how is law translated from cognitive conception to become institutionalized or systematized? Through an analysis of court decisions and interviews, this paper demonstrates the relationship between social security and dependency. It studies the complex ways in which individual and collective human agency relates to social security structures and institutions.

Conceptual Considerations for Understanding Resilience in Healthcare Students.

Increasing attention has been given to the concept resilience in the context of healthcare especially during and post the COVID pandemic. Much of the inquiry and evidence reported has focused on promoting or enhancing resilience in healthcare for improving the quality of care and reducing medical negligence. This discursive paper aims to highlight how resilience is conceptualised and identify any potential limitations or gaps in the context of healthcare students, acknowledging considerations for further development and research into this topic. This discursive discussion draws on relevant theoretical underpinnings from the fields of adjustment and coping psychology, and research and evidence from health sciences, for facilitating an understanding of resilience in supporting healthcare students to adapt into professional practice. Investigation of resilience in healthcare students is mainly identified at an individual level as personal traits or skills for working within complex healthcare systems and clinical environments. Less attention has been given to examining resilience at the organisation or systemic level. This is primarily because of limited frameworks for investigating resilience from a multidimensional perspective recognising a wider systemic level influenced by external factors including socioecological determinants, for example, available support services for healthcare students. The link between resilience and its function to mitigate against associated neuropsychological distress and subsequent pathopsychological disorders in healthcare student cohorts is recognised; however, greater understanding of resilience as a multidimensional construct is warranted. A multidimensional investigation of resilience is critical for the preparation and readiness of healthcare structures and organisations in facilitating the needs of healthcare students entering challenging and diverse healthcare working environments. No patient or public contribution.

Halal and Muslim-Minority Countries: A Systematic Literature Review

Muslim-minority countries have emerged among the largest exporters of halal products for the Muslim market and received significant numbers of inbound Muslim travellers. The global nature of the halal industry value chain calls for a thorough understanding about halal, particularly in the context of Muslim-minority countries. To gain this understanding, a systematic literature review was conducted to explore the themes of halal research in Muslim-minority countries. A total of 22 empirical research articles were analysed based on a review protocol adapted from ROSES. The articles were sourced from the Scopus and Web of Science, with Google Scholar as a supplementary database. The study generated five main themes that synthesise the scholarly knowledge about halal in the context of Muslim-minority countries at the consumer, organization, and institution levels of analysis. The findings illustrate the lack of understanding about halal among the industry players and consumers, as well as the lack of central governance and policymaking within the halal industry in Muslim-minority countries. Based on the findings, the study provides future direction for research and practice.

Towards a New Integrated Model for Taking Into Account the Experiential Knowledge of People With Chronic Diseases, Integrating Mediation, Therapeutic Education and Partnership: The Expanded Chronic Care Patient-Professional Partnership Model.

The Chronic Care Model (CCM), the Expanded Chronic Care Model (ECCM) and the eHealth Enhanced Chronic Care Model (eCCM) focus on how healthcare teams and eHealth support can offer effective care and relevant solutions for patients facing chronic care conditions. However, they do not consider how patients can help these teams in their work, nor do they promote ways in which patients can help themselves. However, in the last decade, three different models have emerged that can complete our capacity to design and deliver integrated care for people with chronic diseases. In this article, we propose a revised version of the model that integrates the patient perspective and patients' experience-based knowledge. It integrates three different ways of engaging patients that complement the other patient engagement point of view: the experience of care and mediation in healthcare, therapeutic patient education and patient learning pathways, as well as patient-professional partnership. For each of the three models, we conducted a review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct and government reports on patient engagement and partnership with their healthcare providers, to integrate the different components of these models into the ECCM and eCCM. The goal is to create a model that better takes into account the experiential knowledge of patients and citizens throughout its different dimensions. We identified 129 papers based on their framework, design, sample, measures and fit with patient engagement and chronic illness and added our own research when relevant. Integrating the three models provides an opportunity to amplify the role played by the patient perspective in the management of chronic disease. The Expanded Chronic Care Patient-Professional Partnership Model (E2C3PM) is intended to rebalance power relations between healthcare professionals and patients (and their caregivers). This new model is based on recognizing patients' experiential knowledge and their roles as caregivers and as full members of the care team. Integrating patient empowerment into the E2C3PM underscores the importance of coproduction care with patients at the clinical, organizational and system levels within a supportive environment. Applying this new model should make it possible to better take into account the complexity of chronic diseases, improving the integration not only of care, services and eHealth support but also the various determinants of health and reaching a mutually beneficial settlement among all actors involved. A patient-researcher contributed to the development of the protocol, the data collection and the preparation and writing of this manuscript.

Exploring frailty perspectives of older people and professionals: a systematic integrative review

Abstract Frailty is a common but complex phenomenon that is approached from theoretical and professional perspectives but rarely from the perspectives of older people and their essential stakeholders. Different or opposing perspectives on frailty at personal, organisational, and community levels can negatively affect care for frail older people. This systematic integrative review synthesises the perspectives on frailty of older people, health/social care professionals, informal caregivers, managers and policymakers, using thematic analysis. We use the Joanna Briggs Institute–Critical Appraisal Checklist to appraise the quality of 52 qualitative and mixed-method studies drawn from the PubMed/MEDLINE, CINAHL, PsycINFO, Embase, and Web of Science databases (inception–December 2023). Of these, 33 include the perspectives of older people, 27 of health/social care professionals, four of managers, and six of informal caregivers. Structuring the perspectives along six themes – ‘the multi-dimensional nature of frailty’, ‘the dynamics of frailty’, ‘the complexity of frailty’, ‘frailty in relation to age’, ‘frailty in relation to health’ and ‘frailty in relation to dependence’ – revealed substantive similarities in the conceptualisation of frailty between older people and professionals, e.g. regarding frailty’s dynamic and multi-dimensional nature. However, older people and professionals differ in their interpretations of frailty: older people take a personal view, while professionals take a more practical view. The identified discrepancies in perspectives may affect care relationships and care for frail older people. Therefore, we advocate a systems approach that incorporates multiple perspectives to form a comprehensive view of frailty and allows for a situation-specific shared understanding of frailty in older people.

A structural investigation on the interactions of cotton fabric cellulose with olive oil and water

The cotton fabric consists of cellulose arranged in a complex structure with multiple levels of organization at different length scales. Understanding this structure and its interactions with water and oil is essential for developing efficient and environmentally friendly methods of cotton washing. In this study, the structure of raw cotton fabric cellulose and the effects of water and oil were examined across a broad range of length scales using spatially resolved synchrotron small-angle X-ray scattering (SAXS) and auxiliary techniques.Water was observed to penetrate the cotton fabric and interact across nearly all length scales. Although a certain amount of the material was not affected by water as seen by intact distance between microfibrils, fractal analysis of the scattering data indicated a loosening of the microfibril arrangement after contact with water. This process was hindered if the material had been pre-treated with oil and was not seen after subsequent washing with water or surfactant solution. Analyzing spatially resolved SAXS data using a bi-sinusoidal model and 2D maps of the oil-to-cotton ratio facilitates understanding the structure of the material and its interactions with oil on the molecular, nano and macrolevels.

What Enables Implementation of Pain Management Interventions in Intensive Care Units and Why: A Realist Evaluation to Refine Program Theory.

To uncover perspectives and refine 12 initial program theories concerning the implementation of pain management interventions in intensive care units. Contexts enabling implementation are delineated, and causal mechanisms within these contexts are described. A realist evaluation approach was employed. Fourteen purposively selected Australian nurses of variant roles were virtually and individually interviewed between July and September 2023. Participants were presented with initial program theory, and their perspectives were collated. Data were analysed using an integrated approach of context (C), mechanism (M), outcome (O) categorisation coding, CMO configurations connecting and pattern matching. Pain management interventions work if perceived to be beneficial, precise, comprehensive and fit for purpose. Nurses should be willing to change attitudes and update knowledge. Unit leaders should nurture the development of nurses' professional identity, access to learning, autonomy and self-determination. Organisations should change the infrastructure, provide resources, mitigate barriers, develop shared mental models, update evidence and institute quality assurance. Adherence to interventions is affected by the outcomes of implementation and intrinsic merits of interventions. In these contexts, confidence is boosted; feelings of empowerment, self-efficacy, reflective motivation, trust, awareness and autonomy are developed; and capacity is built. Furthermore, frustration from the variability of practices is reduced, accountability and ownership are augmented, yielding positive implementation outcomes. Findings have implications on nurses, team leaders and organisations concerned with implementation. The findings provided a fortified understanding of conditions favouring successful implementation of pain management interventions. Actions should be undertaken at an individual, unit and organisation level to ensure successful implementation. RAMESES II Reporting Standards for Realist Evaluations informed presentation of study. Intensive care nurses contributed insights to refine the program theory.

Struggling with strategizing in public client organisations: Managing strategic projects in inter-organisational contexts

The efficiency of using strategic projects to accelerate long-term change is questioned, especially in inter-organisational contexts. Strategic projects operationalised in inter-organisational contexts are decoupled from the parent – permanent – organisation, creating a need for project actors to manage in-between. The aim of this paper is to increase the understanding of practices for managing strategic projects in inter-organisational contexts, initiated by public client organisations. Applying a practice perspective, this paper presents a case study exploring a strategic project to test collaborative contracting in road maintenance contracts for a public infrastructure client in Sweden. The findings revealed a lack of structure regarding both participation and responsibilities, as well as uncertainties and ambiguities with respect to the goal of the strategic change. The study shows how strategic practices move from central units at the permanent organisational level to the contract level where the strategic project is operationalised and tested, isolating the project and making project actors act as middle managers in-between the project and parent organisation. Thus, the study contributes with a discussion on the efficiency of strategizing through projects in public organisations, especially those operating in a network of suppliers through outsourcing.

Fostering a Continuous Learning Environment: Keys to Unlocking Your Organization's Full Potential

Abstract: This article explores how organizations can establish a culture of continuous learning to help unlock their full potential. The article begins by defining continuous learning and outlining its benefits at both the individual and organizational levels based on research. It then discusses essential components for creating a true continuous learning environment, including leadership support, structured processes, goal planning, and hands-on approaches. Practical strategies are provided for integrating continuous learning depending on industry context, such as technology, manufacturing, healthcare and marketing. The author argues that cultivating a culture where ongoing learning is ingrained will empower individuals, teams and the overall business to adapt, improve and thrive.

Metabolic Monitoring for Children and Adolescents Prescribed Second-Generation Antipsychotics: A Qualitative Study with Child Psychiatrists.

Introduction: Professional guidelines recommend that providers routinely monitor children prescribed second-generation antipsychotics (SGA) to reduce the risk of adverse metabolic events associated with the medication. Despite this guidance, many studies show low rates of monitoring compliance. In this study, we interviewed child psychiatrists for their views of possible barriers to monitoring. Methods: Semi-structured qualitative interviews, developed according to the Regehr model of influences upon patient-provider decision making, were conducted with child and adolescent psychiatrists in current practice and recruited by convenience and snowball sampling. Interviews were conducted through internet video meetings and were recorded. Interview data were analyzed following Framework Analysis qualitative methods. Results: We recruited and completed interviews with 17 psychiatrists. Patient-level barriers included travel difficulties, limited family time for health care appointments, patient fear of blood draws, and more. Provider-level barriers included professional judgment versus guideline guidance, perceived family burden, assumption of low-risk, short-term SGA use, and more. Organizational level barriers included lack of organizational mandates or incentives, limited appointment time per patient, lack of care coordination, lack of co-located labs, personnel turnover, and more. Barriers at the social and cultural level include stigma and low health literacy. Conclusion: These practicing prescribers provided a wide range of possible barriers to metabolic monitoring in children and adolescents prescribed SGAs. The next step is to explore which may be present in certain settings, and to pilot quality improvement interventions. Addressing barriers can reduce risk of metabolic disorders arising from long-term use of SGAs in children and adolescents.